Clinical manifestations of adrenal hemorrhage vary depending on the degree and rate of hemorrhage, as well as the amount of adrenal cortex compromised by hemorrhage. We report here a case of neonatal adrenal hemorrhage that presented with late onset neonatal jaundice. The cause of adrenal hemorrhage was birth asphyxia.

Objectives:(1) To determine the frequency of abnormal neuroimaging in children with new-onset afebrile and complex febrile seizures; (2) to draw a correlation between Electroencephalogram (EEG) and neuroimaging.Study Design:A hospital-based prospective study.Materials and Methods:A total of 276 children (6 months to 14 years of age), who presented with new-onset afebrile or complex febrile seizures, underwent EEG and neuroimaging [Computed Tomography (CT) and/or Magnetic Resonance Imaging (MRI)].Results:Generalized seizures constituted the major seizure group in our study – 116/276 (42%) – followed by partial seizures 86/276 (31.2%) and complex febrile seizure in 64/276 (23.2%). Generalized as well as partial seizures were more common in children aged 6-14 years, while complex febrile seizures were predominantly seen in children less than 6 years old. Most of the patients with generalized and partial seizures had EEG abnormalities, while EEG abnormalities were uncommon in patients with complex febrile seizures. A total of 27/276 (9.8%) patients with seizure disorder had abnormal CT scans and this abnormality was more common in patients with partial seizures. CT abnormality was seen more commonly in those patients who had an abnormal EEG. EEG and CT correlation showed that patients with abnormal EEG had higher rates of CT abnormality, ie, 16.1% (25/155). Abnormal MRI was seen in 32/157 (20.4%) of patients; accuracy of picking abnormality by MRI, when EEG was abnormal, was 24.8% (P<0.05).Conclusion:Our findings indicate that clinical examination and EEG results are good indicators for neuroimaging, and these can be used as one of the criteria for ordering neuroimaging in new-onset seizures.

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A three year retrospective study was done to study snakebite envenomation among Kashmiri children. Ten children were admitted with snakebite. Snakebite was vasculotoxic in seven and mixed in two. Levantine viper bites were seen in five who had Grade 3 bites with severe local signs, severe coagulopathy and hypotension. Both environmental risk and seasonal incidence was observed.

BACKGROUND Low back pain combined with radicular pain is one of the most challenging musculoskeletal problems for therapeutic management with a lifetime prevalence estimated to be around 40% to 60%. We wanted to observe the results of therapeutic transforaminal epidural steroid injection for lumbosacral nerve root pain with regard to pain relief, patient satisfaction and improvement in return to work status before and after the injection. METHODS This study was conducted in the postgraduate department of orthopaedics, Govt. Hospital for Bone and Joint Surgery, an associated hospital of Govt. Medical College, Srinagar from Sept. 2016 to Sept. 2018. The study consisted of a total of 100 patients. Patient was explained in detail about the Visual Analogue Scale (VAS) and Oswestry Questionnaire. RESULTS A total of l00 patients with 53 % males 47 % females was included in this study. The mean age was 40.3 years. 59 % of patients had right sided radiculopathy and 41% had it on left side. The average duration of symptoms was 4.13 months with standard deviation of 0.788. The average pre injection SLR was 59.20 0 which increased post injection to an average of 85.35 0 (p-value<0.001). 88 of the patients had a lateral disc herniation and central prolapse of disc (4%) on MRI. 42% received L5 TFESI followed by S1 (40%). Mean VAS before injection was 5.98 with S.D. of ±1.359. The mean VAS after 6 months was 2.25 ± 1.316. Mean pre-injection ODI was 32.95 (S.D. of 8.26). After TFESI, it dropped to 11.91 at 1 week, 12.03 at 4 weeks and increased a bit to 15.63 with S.D. of 5.03. p-value<0.001. 63% of our patients had excellent outcome, 33% had good, 3% had fair and 1% had poor outcome as measured by modified McNab scale. CONCLUSIONS Transforaminal epidural steroid injection is an effective alternative method of pain control with improvement in disability with excellent patient satisfaction in properly selected patients of lumbosacral radiculopathy.

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